Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases

Élias, Dominique; Ouellet, Jean-François; Bellon, Nicolas; Pignon, Jean-Pierre; Pocard, Marc; Lasser, P

doi:10.1002/bjs.4071

Cited by 213 publications

(138 citation statements)

References 31 publications

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“…Historically, concerns regarding the safety of such an extensive operation have been raised, but most series reported in the last decade revealed that the short-term results achieved in these patients were similar to those observed in patients undergoing surgery for liver-limited metastases (10,26,27). A similar trend was also observed in the present series, with no significant differences in morbidity and mortality rates between CHMs group and CHEHMs group, except for the patients undergoing major hepatectomies in the early period of this study.…”

Section: Discussionmentioning

confidence: 92%

“…In 2003, Elias et al reported (in a study of 111 patients with CHEHMs) a 5-year overall survival rate of 20% (10).…”

Section: Discussionmentioning

confidence: 99%

“…In 2012, more than 55,000 deaths from this disease occurred in the United States and about 214,000 deaths were registered in Europe. In Romania, in 2012 colorectal cancer occupies the second place among adult cancers, both in terms of incidence (10,256 new cases) and mortality (approximately 5,500 deaths) (1).…”

Section: Introductionmentioning

confidence: 99%

“…In the last decade, some authors reported favorable survival results in selected patients with CHEHMs, in which complete resection of all metastatic disease (8)(9)(10)(11) could be performed. Currently, several centers consider that the presence of CEMs is no longer an absolute contraindication to liver resection (if complete resection of hepatic and extrahepatic disease can be performed), extrahepatic disease representing only a poor prognostic factor for patients with CHMs.…”

Section: Introductionmentioning

confidence: 99%

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Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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Introducere: Beneficiul rezecţiei hepatice în cazul metastazelor hepatice şi extrahepatice colorectale (MHEHCR) este încă discutabil. Scopul acestui studiu este de a evalua rezultatele rezecţiei metastazelor hepatice şi extrahepatice efectuate pacienţilor cu MHEHCR într-un centru medical cu un volum mare de intervenţii chirurgicale, atât în sfera chirurgiei hepato-biliare, cât şi în sfera chirurgiei colo-rectale şi de a identifica factorii de prognostic care se corelează cu o supravieţuire îndelungată. Metoda: Studiul este unul retrospectiv şi se bazează pe un lot de 678 de pacienţi consecutivi, cu metastaze hepatice ale cancerului colo-rectal operate într-un singur centru chirurgical, în perioada aprilie 1996 -martie 2016. Dintre aceştia, 73 de pacienţi au prezentat MHEHCR. Analiza univariată a fost efectuată pentru identificarea acelor factori de risc ce influenţează supravieţuirea generală (SG) . Rezultate: Au fost 20 de metastaze extrahepatice localizate la nivelul pediculului hepatic, 20 la nivel peritoneal, 12 la nivel ovarian şi pulmonar, 9 cu alte localizări şi 12 recidive locale. Au fost efectuate 53 de rezecţii curative (RO). Supravieţuirea Original ArticleChirurgia (2017) comparativă între lotul pacienţilor cu MHEHCR şi cel al pacienţilor cu metastaze strict hepatice a arătat o diferenţă semnificativă statistic în favoarea celui de-al doilea lot (p <0,0001), acelaşi rezultat fiind înregistrat şi în prezenţa rezecţiei R0 în cele două loturi (p <0,0001). În grupul MHEHCR, SG a fost semnificativă statistic mai mare la pacienţii care au beneficiat de rezecţie R0 faţă de cei la care rezecţia a fost R1/R2 (p = 0,004). Analiza univariată a identificat trei variabile drept factori de prognostic negativ pentru SG: 4 sau mai multe metastaze hepatice, efectuarea unei hepatectomii majore şi perioada realizării rezecţiei hepatice (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Localizarea ovariană sau pulmonară a metastazelor extrahepatice este corelată cu cea mai bună rată de supravieţuire dintre toate localizările posibile dar fară a fi semnificativă statistic. Concluzie: La pacienţii cu metastaze hepatice şi extrahepatice concomitente, rezecţia completă (R0) a acestora prelungeşte în mod semnificativ supravieţuirea. Pacienţii cu mai puţin de 4 metastaze hepatice, a căror rezecţie este realizată printr-o hepatectomie minoră sunt cei care beneficiază cel mai mult de pe urma acestei conduite terapeutice onco-chirurgicale agresive.Cuvinte cheie: metastaze hepatice ale cancerului colo-rectal, metastaze extrahepatice, metastaze hepatice şi extrahepatice ale cancerului colo-rectal, rezecţie hepatică, supravieţuire generală, factori de prognostic AbstractBackground: The benefit of hepatic resection in case of concomitant colorectal hepatic and extrahepatic metastases (CHEHMs) is still debatable. The purpose of this study is to assess the results of resection of hepatic and extrahepatic metastases in patients with CHEHMs in a high-volume center for both hepatobiliary and colorectal surgery and to identify progn...

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Section: Discussionmentioning

confidence: 92%

“…In 2003, Elias et al reported (in a study of 111 patients with CHEHMs) a 5-year overall survival rate of 20% (10).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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show abstract

“…A careful and individual evaluation of (67,74), and also series with simultaneous resection of hepatic and extrahepatic metastases have demonstrated 5-year survival rates approaching 30% (45,75). The intrahepatic tumour number as an exclusion criterion for liver surgery is still a matter of debate.…”

Section: Resection Of Recurrencementioning

confidence: 99%

Follow-up after Colorectal Cancer Surgery

Ohlsson

Pålsson

2003

Acta Oncologica

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A Second Liver Resection Due to Recurrent Colorectal Liver Metastases

Cunha

Laurent²,

Rault³

et al. 2007

Arch Surg

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Background: Repeat liver resection because of recurrent colorectal liver metastases can provide survival benefit with a low rate of complications. Design: Retrospective study. Participants: Forty patients who underwent a second hepatectomy because of liver metastases from colorectal cancer. Main Outcome Measures: Short-and long-term results of a second hepatectomy and determination of prognostic factors. Results: The postoperative mortality rate was 2.5%. The postoperative morbidity rate was not significantly different after a second hepatectomy compared with single hepatectomy (42.5% and 27.5%, respectively; P = .10). Transfusion requirement and hospital stay were comparable for both a single and a second hepatectomy. Threeand 5-year overall survival rates were 55% and 31%, respectively. Disease-free survival rates at 3 and 5 years were, respectively, 49% and 27%. The interval between first and second hepatectomies and the presence of extrahepatic disease were independently related to survival (multivariate analysis). Conclusions: A second liver resection because of recurrent liver metastases from colorectal cancer is safe and provides a survival benefit similar to that with single hepatectomy. Our analysis suggests that the benefit of treatment is limited in patients who undergo a second hepatectomy within 1 year of the first operation and in those with extrahepatic disease.

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Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases

Cited by 213 publications

References 31 publications

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Follow-up after Colorectal Cancer Surgery

A Second Liver Resection Due to Recurrent Colorectal Liver Metastases

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